【作者】 冯保同；

【导师】 郭农建；

【作者基本信息】 山东大学 ， 内科学， 2010， 硕士

【摘要】 目的：综合评价国内美罗华联合CHOP方案对非霍奇金淋巴瘤的疗效和安全性。方法：计算机检索Pubmed(1999-2010),Elsevier(1990-2010),中国学术期刊全文数据库(CNKI)(1994-2010),中文科技期刊数据库(1989-2009),万方数据库(1982-2010)和中国生物医学文献服务系统(1980-2010),并手工检索所有纳入文献的参考文献,纳入国内美罗华联合CHOP方案治疗非霍奇金淋巴瘤的随机对照试验(RCT)和临床对照试验。评价纳入研究的方法学质量并进行资料提取后,采用RevMan 4.2软件进行Meta分析。结果：共纳入13个研究,包括684例患者。Meta分析结果显示,美罗华联合CHOP方案与单用CHOP方案相比：①总有效率[OR=3.10,95%CI(2.10,4.56)]、完全缓解率[OR=2.44,95%CI(1.78,3.35)]明显提高,差异均有统计学意义(P均<0.00001)；②部分缓解率[OR=0.90,95%CI(0.63,1.28)]无明显改善(P=0.55)；③1年总生存率[OR=2.03,95%CI(1.05,3.90)]、2年总生存率[OR=2.30,95%CI(1.24,4.26)]、3年总生存率[OR=3.02,95%CI(1.38,6.60)]均明显提高,差异均有统计学意义(P值分别为0.03、0.008、0.006)；④两组白细胞减少[OR=0.97,95%CI(0.60,1.55)],贫血[OR=1.02,95%CI(0.56,1.88)],恶心、呕吐[OR=0.88,95%CI(0.58,1.33)],脱发[OR=0.88,95%CI(0.50,1.56)]及肝功能损害[OR=0.77,95%CI(0.41,1.42)]等各不良反应发生率差异无统计学意义(P值分别为0.88、0.94、0.53、0.66、0.40)。结论：目前国内的有限证据表明,与单用CHOP方案相比,美罗华联合CHOP方案能明显增加非霍奇金淋巴瘤治疗的总有效率和完全缓解率,延长患者的生存期,并不增加毒副作用,但由于纳入研究样本量小且质量较低,上述结论尚需要高质量、大样本的随机双盲对照试验加以证实。更多还原

【Abstract】 Objective:To assess the efficacy and safety of rituximab combined CHOP for treating Non-Hodgkin’s Lymphoma in China.Methods:Randomized controlled trials(RCTs) and clinical trials of rituximab combined CHOP for treating Non-Hodgkin’s Lymphoma in China were collected from Pubmed (1999-2010), Elsevier (1990-2010), CNKI (1994-2010), VIP (1989-2009), WanFang Data (1982-2010), and CBM (1980-2010) databases. Other relevant journals were also handsearched. The methodological quality of the included studies was evaluated, and data analyses were performed using the Cochrane Collaboration’s software RevMan 4.2.Results:A total of 13 trials involving 684 patients were included.①As for the total effective rate and complete remission rate, significant differences were found between rituximab+CHOP vs CHOP alone[OR=3.10,95 % CI (2.10,4.56);OR=2.44,95 % CI (1.78,3.35)];②As for the partial remission rate, differences between rituximab+CHOP vs CHOP alone did not reach significant(P=0.55)[OR=0.90,95 % CI(0.63,1.28)];③As for the overall survival rate of 1 year,2 years, and 3 years, significant differences were found between rituximab+CHOP vs CHOP alone [OR=2.03,95 % CI (1.05,3.90);OR=2.30,95 % CI (1.24,4.26);OR=3.02,95 % CI (1.38,6.60)];④As for the adverse effect rate of leukopenia, anemia, nausea and vomiting, alopecia, and liver damage, differences between rituximab+ CHOP vs CHOP alone did not reach significant [OR=0.97,95 % CI (0.60,1.55); OR=1.02,95 % CI(0.56,1.88);OR=0.88,95 % CI(0.58,1.33);OR=0.88,95 % CI (0.50,1.56);OR=0.77,95 % CI (0.41,1.42)].Conclusion:According to the domestic evidence, treatment for NHL with R-CHOP can significantly improve the total effective rate and the complete remission rate, extend the survival without more adverse effect rate. However, more high-quality, large-sample, randomized, double-blind, controlled trials are required.更多还原